"Coached pushing offers little immediate benefit" was the conclusion of a study published in the American Journal of Obstetrics and Gynecology 2006; 194: 10-3. The benefits of routine coached pushing during the second stage of labor are being increasingly debated. Indeed, results of a previous randomized controlled trial by the research team found it to be associated with evidence of pelvic floor dysfunction 3 months after delivery.

To investigate the impact of such pushing on delivery and infant outcomes, Steven Bloom and colleagues (University of Texas Southwestern Medical Center, Dallas, USA) randomly assigned nulliparous women with straightforward labors and without epidural analgesia to perform coached (n = 163) or uncoached (n = 157) pushing during the second stage.

Indeed, "the short-term outcome findings that coached pushing confers neither benefit nor harm might be preempted if it is confirmed that coaching has deleterious long-term effects," warned the investigators.

Like circumcision, some things take a long time to surface in the media and forums for public date. I have opposed "Purple Pushing" for my entire career, beginning with the first edition of my first book, Essential Exercises for the Childbearing Year, in 1976. My chapter on "Maternal Effort During Labor and Delivery" was published, in McKenna Julie, ed. International Perspectives in Physical Therapy: #3 Obstetrics and Gynaecology, Edinburgh: Churchill Livingstone in 1988. Now it is 2006 and some people are starting to pay attention!

The urge to push is triggered by the pressure of the baby's head on the unanesthetized pelvic floor muscles. This increase levels of the hormone oxytocin that strengthens the uterine contractions until they become irresstible. Pushing before the urge is pointless. Breath-holding is harmful. The uterus contracts radially (like making a fist) not axially. The walls of the uterus move in from all sides, reducing the dimension. The mother's abdominal muscles follow suit. This is spontaneous and usually involves primal sounds since the vocal cords fill with blood to protect them as they slow down the exhaled breath. No coach standing beside the mother can experience the urge—only she.

Birds fly, fish swim, women do birth. They need confidence and courage to celebrate this experience of their most creative female power—not coaching.